Just back from Vancouver! There were about 3,000 participants at the ASAPS meeting in the Vancouver Convention and Exhibition Centre, which began Thursday, May 3, 2012. Attendees were mostly board certified plastic surgeons from the U.S., with other plastic surgeons from Latin America and Europe. After attending the Scientific Sessions over the weekend, and enjoying the scene at the Fairmont Pacific Rim lobby bar, here is what I came away with:


Facial rejuvenation remains all about volume, the addition of volume to a deflated face using either fat, or any of the other available injectables, such as Juvederm, Restylane, Radiesse, and Sculptra, which are most commonly used. Blunt-tipped cannulas instead of sharp needles are being used for the injections to decrease bruising as well as avoid damage to surrounding blood vessels and nerves. We will definitely use these in our practice, especially around delicate areas such as the eyes which are prone to bruising. Most injectables are lasting about 1 year. Sculptra can last several years. Fat can last much longer, but reabsorption of fat can be unpredictable, and often patients need touch-up procedures. Fat is generally not recommended around the eyes, as complication rates are high, and lumpiness or visibility can be difficult to correct. Hyaluronic acid products such as Restlyane and Juvederm are more forgiving, as there is an enzyme called Vitrase (hyaluronidase), which can immediately dissolve these products if there is any undesirable effect.

It is also interesting to see that the addition of volume to the face is commonly “overdone” and there is population of patients with overdone fillers that look unnatural and distorted. As I look around the room during this scientific session, I see several of these people in my vicinity. Also called the Cat-Face, the biggest problem here is too much cheek fillers. If too much is put in, the enlarged cheek presses against the eye, making it look smaller and slanted. Too much filler also gives the face a triangular look: wide at the cheekbones and comparatively narrow at the jaw. In moderation, this is a youthful shape; but in excess, it just adds to the feline quality. So why are people paying for this? The mentality here is, “Why not put in more and look even better?” This emotional response is something I see regularly in women who get breast enlargement–the swelling goes down, and 9 times out of 10 they want bigger implants. Its like any addiction– wanting more of what is making them happy. But what happens is that individuals can forget what they used to look like and lose all sense of proportion and reality.

Volume needs to be added naturally in moderation, and done in a subtle manner, especially around the cheeks and lower lids to avoid the “cat face”. If volume is being used as the primary modality for facial rejuvenation, it must also harmonize with contiguous areas, such as the neck. If the neck is loose and wrinkled alongside a plumped-up pillow face, the whole appearance looks unnatural and discordant. At that point, it is time for a facelift or necklift, and some backing-off of the fillers.

Mini-facelifts continue to be popular, but realize that despite the decreased invasiveness of the procedure, the recovery process can be similar to more aggressive procedures. Bruising and swelling is more a result of an individual’s response to a procedure and is unpredictable, more so than the extent of the procedure. Some patients tend to bruise and swell more, even if they have had a minimally invasive rejuvenative procedure, and they stay home for 2-3 weeks until they feel comfortable in public. Other patients may go through a full face and neck lift, and have relatively mild bruising and swelling, getting back to work comfortably in 7-10 days. Regardless of the nature of the facial surgical procedure, expect 2-3 weeks of relative social inactivity, and sometimes 6 weeks for naturalness. Facelifting is individualized per patient, not one procedure has shown better results than the other. Most patients and physicians expect 6-10 years of longevity in the results for most normal individuals who maintain a healthy lifestyle.

Stay tuned for part 2 and 3 of this blog discussing BREAST AND BODY.

Dr. Hayley Brown MD, FACS
Breast Augmentation Las Vegas Surgeon
Desert Hills Plastic Surgery Center, Henderson and Las Vegas, Nevada

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